Uncovering PM&R: An engaging elective experience
A collaboration between Case Western and MetroHeath introduces PM&R to first year medical students
As a first-year medical student with little more than a month of school under my belt, my background in bioengineering drove many of my interests. When I first heard about Dr. Greg Nemunaitis’ spinal cord injury (SCI) elective, I thought of force vectors, exoskeletons, and tricked-out wheelchairs.
One thing that had not been advertised was that this elective was also a gateway to an entire specialty unbeknownst to most first and second year medical students. Over the course of ten sessions, my appreciation for engineering grew. Even more inspiring was the way that PM&R specialists, orphysiatrists, straddle a line between coach, innovator, and confidante. They help those with spinal cord injury — congenital or acquired — engineer their lives to achieve the things they want to accomplish.
Dr. Nemunaitis and Mary Jo Roach, PhD directed the elective at the MetroHealth Medical Center. From the start, we learned that there is more to SCI medicine than neurology and orthopedics. The course introduced students to therapies ranging from nerve stimulation for regaining muscle tone to treatment of erectile dysfunction for patients who wanted to start a family. Students met guest speakers who spoke about their own experiences as SCI patients, and highlighted some of the ways their lives had changed post-injury. One young woman I met was several weeks pregnant with her first child, and during our conversation I learned more about the dangers of autonomic dysreflexia than obstetrics. My classmates also experienced what it was like to navigate through an obstacle course using a wheelchair. As expected, it was a real arm workout!
We learned that not all spinal cord injuries are created equal, and not all people with a similar injury experience a similar recovery. Some adaptations are more psychological than they are physical. A good support system, access to knowledgeable physiatrists, tailored physical therapy, and patience are crucial to overcoming the psychological and physical effects of an SCI. I realized that during my time as an undergraduate student, I had taken part in this network of support by volunteering as a swimming teacher for children with cerebral palsy and other special needs. Not only was I teaching a valuable life skill, I was also teaching children and families that movement and play are still possible with limited mobility.
A good physiatrist coordinates the physical, occupational, recreational, and psychological aspects of patient care. Spinal cord injury medicine is a field that will continue to require imagination and adaptation because every patient’s path to recovery is different. I am excited that the next round of this elective will offer students even more opportunities to create custom devices for SCI patients using 3D-printing to rapidly prototype objects. This interactive model of education is instrumental in spurring student learning and engagement in PM&R. It is my hope that more students are able to take courses like this, explore SCI medicine, and have the opportunity to work with some of the inspirational patients and physicians in this field.
Helen Sun is a third-year medical student at Case Western Reserve University School of Medicine with interests in spinal cord injury medicine, engineering, and writing.
